Abstract

Objective: To assess the incidence, risk factors, and surgical indications related to recurrent lumbar disc herniation (rLDH) and persistent postoperative pain following lumbar discectomy.
Methodology: A systematic review of randomized controlled trials (RCTs), cohort studies, and large case series published between 2010 and 2025 was conducted. Searches were performed in PubMed, MEDLINE, and Cochrane Library databases following PRISMA guidelines. Studies involving adult patients with lumbar discectomy were included, focusing on recurrence, persistent pain, and indications for reoperation.
Results: Recurrence rates ranged from 5-15%, typically occurring within 1-5 years. Persistent postoperative pain affected up to 27% of patients. Key risk factors included smoking, diabetes, obesity, Modic changes, disc extrusion, and incomplete disc removal. Reoperation rates varied between 0.5% at one year and up to 19% in long-term follow-up. Fusion surgery was indicated in selected cases with instability or repeated recurrence.
Conclusion: Both recurrent herniation and persistent pain require a comprehensive, individualized approach. Early identification of risk factors and precise surgical execution are critical to minimizing complications. Future research should emphasize predictive modeling and evidence-based criteria for second surgery.

Key words: Lumber disc, disc prolapse, persistent pain.